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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 19 recordsLinked to original sources
PubMed1995

Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure.

BACKGROUND: To compare the quality of life, nutritional status, and gastrointestinal profiles of post-Whipple patients and postcholecystectomy patients. METHODS: A cross-sectional survey of post-Whipple procedure patients and age- and sex-matched postcholecystectomy patients was performed. Quality of life was assessed using six instruments: Time Trade-off Technique, Direct Questioning of Objectives, Gastrointestinal Quality of Life Index, Sickness Impact Profile, Physician Global Assessment, and Visick Scale. A gastrointestinal symptomatology questionnaire was completed. Nutritional status was assessed by weight, the Subjective Global Assessment instrument, and skin anthropometry. Fasting and postprandial serum gastrin, somatostatin, insulin, pancreatic glucagon, enteroglucagon, and pancreatic polypeptide were measured. RESULTS: The quality of life and gastrointestinal function of the Whipple patients was excellent and was not significantly different from that of the control subjects. There were no significant differences in gastrointestinal symptomatology although 5 Whipple patients complained of greasy bowel movements, and 1 patient reported difficulty maintaining weight. Despite this, nutritional status was within normal limits in all subjects. Six patients in the Whipple group followed a diabetic diet, 1 required insulin, and 3 required an oral hypoglycemic agent, whereas none of the control subjects were diabetic. There were no significant differences in the mean basal, peak, or integrated postprandial responses of the gut hormones with the exception of pancreatic polypeptide and gastrin (in patients having a standard Whipple procedure only). CONCLUSION: Quality of life and nutritional status are excellent in patients following a Whipple procedure.

Adult↗
PubMed1995

The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient.

This study reports the successful use of osseointegrated implants to replace teeth in patients whose periodontal disease has been categorized as recalcitrant. It includes partially and totally endentulous jaws. A total of 309 implants placed by two periodontists practicing in traditional office settings were included in the survey. Of the 132 mandibular implants, 4 failed, for a success rate of 97%; and 3 of the 177 maxillary implants failed, for a success rate of 98%. There were 21 implants placed in 1985; 38 in 1986 and 1987; 185 from 1988 to 1990; 42 in 1991; and 23 in 1992. The report includes 42 mandibular and 50 maxillary prostheses, none of which has failed. One female mandibular case was converted from 2 posterior free-standing to a full arch prosthesis when the anterior teeth failed periodontally. These results demonstrate that individuals with a strong susceptibility to periodontal disease can be treated successfully with osseointegrated implants.

Adult↗
PubMed1995

[Gastroschisis. Management. 50 cases].

OBJECTIVE: Demonstrate the need for a multidisciplinary antenatal approach to laparoschisis. MATERIAL AND METHODS: A retrospective series of 50 children who underwent surgery for laparoschisis between 1975 and 1994 in the Infant Surgery Department of the Strasbourg University Hospitals. Postoperative outcomes were evaluated as a function of the stage of laparoschisis and surgical technique. Follow-up was also examined. RESULTS: Depending on the periods evaluated, ultrasound diagnosis varied from 16 to 92% and was made at 21 weeks gestation on the average. Lesions observed were atresia of the bowel (10%), complete intestinal involution (2%), and perivisceritis (88%). Complete parietal closure was achieved after bowel emptying in 58% of the newborns. Postoperative mortality, usually in vere severe forms, fell from 46% to 15% over the 20-years study period. CONCLUSION: Antenatal echography can confirm the diagnosis of laparoschisis. It can be used to define risk factors (size, bowel dilatation(s), mesenteric blood flow) allowing planned extraction in an Infantile Surgery Unit. This multidisciplinary attitude should help to improve overall outcome.

Abdominal Muscles↗
PubMed1994

Liver transplantation for hepatocellular carcinoma.

Twenty-nine patients with hepatocellular carcinoma (HCC) underwent orthotopic liver transplantation (OLTx) at the University of Toronto. Four patients did not have cirrhosis. Of the 25 patients with cirrhosis, 19 had known or suspected HCC before OLTx. Eleven patients tested positive for the hepatitis B surface antigen (HBsAg). No patients received adjuvant chemotherapy. None of the patients have developed recurrent HCC in a follow-up of 9 to 87 months (mean: 33 months). The actuarial post-transplant survival of all patients at 3 months, 1 year and 3 years was 75%, 61%, and 46%, respectively. The survival of HBsAg-negative patients was 69% at 3 years, whereas HBsAg-negative patients had a 3-year survival of 18% (p = 0.045). These results suggest that OLTx for carefully selected patients with otherwise unresectable HCC is associated with a low risk of recurrence. HBsAg-positive patients with HCC have a high mortality, suggesting that they make poor candidates for OLTx.

Adult↗
PubMed1994

Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation.

OBJECTIVE: This study defined negative outcomes of solid organ transplantation, proposed a new classification of complications by severity, and applied the classification to evaluate the results of orthotopic liver transplantation (OLT). SUMMARY AND BACKGROUND DATA: The lack of uniform reporting of negative outcomes has made reports of transplantation procedures difficult to interpret and compare. In fact, only mortality is well reported; morbidity rates and severity of complications have been poorly described. METHODS: Based on previous definition and classification of complications for general surgery, a new classification for transplantation in four grades is proposed. Results including risk factors of the first 215 OLTs performed at the University of Toronto have been evaluated using the classification. RESULTS: All but two patients (99%) had at least one complication of any kind, 92% of patients surviving more than 3 months had grade 1 (minor) complications, 74% had grade 2 (life-threatening) complications, and 30% had grade 3 (residual disability or cancer) complications. Twenty-nine per cent of patients had grade 4 complications (retransplantation or death). The most common grade 1 complications were steroid responsive rejection (69% of patients) and infection that did not require antibiotics or invasive procedures (23%). Grade 2 complications primarily were infection requiring antibiotics or invasive procedures (64%), postoperative bleeding requiring > 3 units of packed red cells (35%), primary dysfunction (26%), and biliary disease treated with antibiotics or requiring invasive procedures (18%). The most frequent grade 3 complication was renal failure, which is defined as a permanent rise in serum creatinine levels > or = twice the pretransplantation values (11%). Grade 4 complications (retransplantation or death) mainly were infection (14%) and primary dysfunction (11%). Comparison between the first and last 50 OLTs of the series indicates a significant decrease in the mean number of grade 1 and 2 complications. This was partially a result of better medical status of patients at the time of transplantation. Using univariate and multivariate analyses of risk factors, the best predictor of grade 1 complications was donor obesity; for grade 2 complications, the best predictor was a donor liver rewarming time of > 90 minutes, and for grade 3 and 4 complications, the best predictor was the APACHE II scoring system and donor cardiac arrest. CONCLUSIONS: Standardized definitions and classifications of complications of transplantation will allow us to better evaluate and compare results of transplantation among centers and over time, and better compare effectiveness of new therapies. Orthotopic liver transplantation still is a procedure with high morbidity that requires careful analysis of risk factors to optimize selection of patients and organ sharing.

Adolescent↗
PubMed1994

Spontaneous in situ gingival augmentation.

A technique to increase the quantity of gingival tissue around a tooth scheduled for extraction is described. When the tooth is reduced subgingivally, the body will spontaneously produce sufficient amounts of tissue to completely cover the condemned root, thereby simplifying the implant-or socket-retention procedure.

Dental Implantation, Endosseous↗
PubMed1994

[Percutaneous angioplasty and surgical revascularization in renovascular hypertension: experience in treatment and long-term follow up in 124 patients].

PURPOSE: To report the experience in the treatment and long-term follow-up of patients with renovascular hypertension submitted to angioplasty and/or surgical revascularization, and to compare blood pressure and renal function responses to both treatment. METHODS: One hundred and twenty-four patients diagnosed with renovascular hypertension, divided, according to the etiology, as atherosclerosis (76 patients), fibromuscular dysplasia (32) and arteritis (16), were submitted to isolated or associated treatment of renal revascularization by percutaneous transluminal angioplasty (71 patients) or surgery (84). The patients were followed-up during 2.5 +/- 1.5 years and we evaluate blood pressure response and renal function preservation. In relation to blood pressure control, the patients were considered as cured when normotensives without antihypertensives, improved when normotensives with fewer drugs than previously, and unchanged, when out of these criteria. RESULTS: From 124 patients, 20% were considered cured, 54% improved and 26% unchanged, after a mean follow-up of 2.5 +/- 1.5 years. Patients with atherosclerosis and fibromuscular dysplasia presented a higher rate of care and improvement after surgery. The blood pressure and the number of antihypertensive drugs decreased significantly during the follow-up among patients that cured or improved arterial hypertension, either after angioplasty (190 +/- 26/115 +/- 14 mmHg vs 130 +/- 34/85 +/- 7 mmHg. 2.70 vs 1.60 drugs) or after surgery (194 +/- 17/115 +/- 16 mmHg vs 143 +/- 18 mmHg vs 88 +/- 8 mmHg, 1.88 vs 1.51 drugs). It was also observed a significant decrease of serum creatinine among these patients. CONCLUSION: Renal revascularization in patients with renovascular hypertension, either by angioplasty or surgery, is beneficial to control blood pressure and to preserve renal function in the majority of patients.

Adult↗
PubMed1994

[Non-iatrogenic trauma of the brachial artery].

Brachial artery trauma are treated quite frequently in the emergency units. Between January 1987 and December 1990 we studied prospectively 50 patients with brachial artery trauma at the Hospital das Clinicas, of University of Sao Paulo. The patients mean age ranged from 2 to 64 years. Males were predominant with 46 patients. Most of them were white (66%). Penetrating injuries were the most frequent. Most of these injuries were caused by gunshot wounds or stabing. Absence of distal palpable pulses was the predominant finding among the clinical features (94%). 74% of the patients do not present important ischemia. The right side was more affected (34 patients). 14 patients had concomitant nerve injury. 35 patients (70%) were submitted to arterial reconstruction with saphenous vein. 12 patients (24%) had end-to-end vascular anastomoses. 3 patients (6%) were submitted to brachial artery ligation. 2 patients underwent simultaneous median nerve repair. In 3 patients we used fasciotomy. 6 patients developed arterial occlusion following vascular reconstruction and in one of them it was necessary to perform amputation. 2 patients had wound infection with saphenous vein repair disruption. Both were treated with brachial artery ligation and one underwent amputation. One patient died on the post operative period owing to associated lesions. Limb preservation was achieved in 47 patients (94%). 33 (70.2%) had no neurological deficit and 14 (29.7%) had some degree of neurological deficit. None of the patients had venous hypertension at the time of discharge.

Adolescent↗
PubMed1993

Survival after reduced-size liver transplantation is dependent on pretransplant status.

Orthotopic liver transplantation (OLT) in children is characterized by unique problems including a shortage of compatible-size donors resulting in long waiting periods, significant deterioration while waiting, and death before transplantation. To improve the chances of obtaining an organ for the sickest patients, reduced-size liver transplantation (RSLT) was offered to all hospital-bound children starting in July 1988. Since then, 68 OLTs were performed in 58 children. Thirty-six RSLTs were done in 30 children (42% of total 86 OLT, 53% since 1988). The mean weight of the RSLT patients was 13.5 +/- 10.4 kg versus 23.8 +/- 21.9 kg in the full-size (FSLT) group (P < .05). Twenty-five of 39 transplants (71.4%) done in children < 10 kg were RSLTs in comparison to only 10 of 47 (21.3%) in patients > 10 kg (P < .0005). Since 1988, 25 of 34 (73.5%) of all transplants in children < 10 kg have been RSLTs. Average donor to recipient weight ratio in the RSLT group was 4.21:1 versus 1.17:1 in the FSLT group (P < .0001). RSLT was done as a primary procedure in 26 patients and as a retransplant in 10. Mean blood product replacement was significantly higher in the RSLT group both intraoperatively (515.7 +/- 490.9 v 177.2 +/- 278.3 mL/kg, P < .005) and during the first 24 hours postoperation (50.5 +/- 81.8 mL/kg v 16.4 +/- 28.5 mL/kg, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature.

We report a case of tuberculous vertebral osteomyelitis of the first and second cervical vertebrae with extensive adjacent soft-tissue involvement and extension into the mediastinum and bilateral flanks. The clinical presentation of tuberculous vertebral osteomyelitis depends on the vertebrae involved. The characteristic syndrome, Pott's disease, reflects the consequence of infection of the lower thoracic and lumbar spine, the most common site of tuberculous vertebral osteomyelitis. Cervical involvement is unusual: tuberculosis affects the cervical vertebrae in approximately 0.03% of all cases. Tuberculosis of the atlas and axis is even more rare. Characteristic symptoms reported on presentation include fever, weight loss, night sweats, and neck pain and stiffness. Patients may have no neurological manifestations, but findings can range from single nerve-root compression to quadriplegia. Abscess may extend into the retropharynx, mediastinum, and posterior triangles and along the epidural space. Computerized tomography and magnetic resonance imaging are the most useful imaging procedures. Therapy should consist of administration of antimycobacterial antibiotics and--if indicated by the degree of subluxation, by neurological signs, or by cervical instability--surgical debridement and stabilization.

Adult↗
PubMed1993

Primary and secondary hepatic malignancies.

Hepatic malignancy accounts for a large number of cancer-related deaths worldwide. Radiologic evaluation of the liver is critically important in the selection of patients for surgical treatment and newer modalities including computed tomographic arterial portography and intraoperative sonography show promise in the detection of small lesions. Advances in our understanding of the segmental anatomy of the liver, studies of intraoperative hepatic ischemia, and improved care of patients following major hepatic resections have extended the limits of surgical treatment of liver lesions, especially in cirrhotic patients with limited functional reserve. Along with hepatitis B, new data suggest that hepatitis C is also important as an agent causing hepatocellular carcinoma. In addition, the tumor suppressor gene p53 is frequently mutated in aflatoxin-induced hepatoma. In endemic regions, mass screening for early hepatocellular carcinoma appears to increase the surgical cure rate. Resectional surgery remains the best treatment for primary liver cancer and, in selected cases, liver transplantation is worthwhile. Liver resection for some patients with metastases of colorectal origin is now considered standard therapy and studies of regional chemotherapy for liver cancer are beginning to show promise. It remains to be seen whether adjuvant chemotherapy after liver resection will increase cure rates.

Carcinoma, Hepatocellular↗
PubMed1993

[Recurrent cutaneous herpes in the newborn and acyclovir].

The authors report two cases of cutaneous recurrent herpes occurring after a neonatal herpes simplex virus type 2 (HSV2) infection and comment on the role of acute or suppressive therapy by aciclovir (ACV). The two infants were not treated by ACV after the neonatal period. None of the recurrent cutaneous herpes episodes was followed by viral widespread. One case reported by Bergström et al on a relapse of HSV2 encephalitis occurring after a cutaneous herpes in a child argues for the use of ACV in recurrent herpes. However, ACV might alter host defense response to HSV2 infection in neonates and children. Thus, it seems not yet recommended to use ACV either as acute or suppressive therapy in recurrent cutaneous herpes unless a progression of the viral disease is noted.

Acyclovir↗